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Introduction: Dance is a physically demanding art form that often results in musculoskeletal injuries. To effectively treat these injuries, standardized and reliable assessment tools designed to the dancer's needs are required. Thus, the aim of this review is to identify studies that have employed validated tools to assess musculoskeletal injuries in ballet, modern, and contemporary dancers, focusing on describing the content and psychometric quality of the tools used. Methods: This systematic review is registered at PROSPERO (CRD42022306755). PubMed, Cochrane, LILACS, Web of Science and SPORTDiscus databases were searched by two independent reviewers. Articles assessing musculoskeletal injuries with validated tools in ballet, modern and/or contemporary dancers and written in English, Portuguese, or Spanish were included. Non-peer reviewed articles, books, conference abstracts, thesis/review articles, or case design studies were excluded. The original validation studies were compiled when necessary. Two independent reviewers conducted a standardized data extraction and evaluated the methodological quality using an adapted Downs and Black checklist. Results: From the 3933 studies screened, 172 were read to verify if they met the inclusion criteria, resulting in 37 studies included accounting for 16 unique validated tools. Two were imaging exams, one was an injury classification system, and 13 were self-reported injury questionnaires. Only four injury assessment tools were validated for dancers, emphasizing the need for further validation studies for the dance population. Most of the articles (57%) achieved high-quality methodological scores and the remaining (43%) reported medium-quality scores. Conclusions: Valid, reliable, and specific tools to assess dance injuries are lacking in general. For enhanced methodological rigor in future studies, the incorporation of validated tools is recommended to improve methodological quality and facilitate cross-study comparisons. Researchers may consider conducting validation studies, involving processes such as translation into another language, validation of modifications to the original tool, or reporting reliability within the article itself., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Turnout, or external rotation of the lower limbs, is an integral part of classical ballet technique. Contributions of lower limb structures to turnout can be separated into HER (hip external rotation) and NHCTO (non-hip contributions to turnout). This study aimed to review systematically methods used to measure turnout in dance medicine and science research, thereby updating the literature since the Champion and Chatfield review of 2008. CINAHL, EMBASE, PubMed, and Web of Science were searched in January 2018 by two independent reviewers. Peer-reviewed studies measuring turnout in dance were included, except those published prior to March 23, 2006, as that was the last date of publication included in the previous review. Abstracts, theses, and editorials were excluded. From each study, study design, population (sample size, sex, age, genre of dance, and level of training), details of the protocol used, and result of turnout measurement were extracted, as well as reliability data. All included studies were assessed for risk of bias, using either Newcastle-Ottawa scale, AXIS tool, or PEDro scale as appropriate for each study design. A total of 41 studies met the inclusion criteria. Twenty-eight studies measured HER, nine measured NCHTO, and 22 measured total turnout (TTO). An increased number of studies investigated TTO (N = 22; N = 4 passive TTO) and NHCTO (N = 9) since 2006. All studies scored above half the points attainable from their respective tools. Results suggest HER remains the most common protocol for measuring turnout (N = 28), despite the fact it disregards input from structures below the hip. It is concluded that researchers should focus on quality of reporting of protocols to ensure repeatability and facilitate comparison of results. Future studies should include absolute reliability and validity testing of all currently used protocols so that standardization can be fully achieved.

The aim of this study was to develop and assess the reliability and validity of a multi-stage, ballet-specific aerobic fitness test to be used in a dance studio setting. The test consists of five stages, each four minutes long, that increase in intensity. It uses classical ballet movement of an intermediate-level of difficulty, thus emphasizing physiological demand rather than skill. The demand of each stage was determined by calculating the mean oxygen uptake during its final minute using a portable gas analyser. After an initial familiarization period, eight female subjects performed the test twice within seven days. The results showed significant differences in oxygen consumption between stages (p < 0.001), but not between trials. Pearson correlation co-efficients produced a very good linear relationship between trials (r = 0.998, p < 0.001). Bland-Altman reliability analysis revealed the 95% limits of agreement to be ± 6.2 ml·kg(-1)·min(-1), showing good agreement between trials. The oxygen uptake in our subjects equated positively to previous estimates for class and performance, confirming validity. It was concluded that the test is suitable for use among classical ballet dancers, with many possible applications.

Most ballet dancers will suffer at least one injury a year. There are numerous causes of injury in dance, and while many investigators have documented risk factors such as anatomical characteristics, past medical history, menstrual history, dance experience, length of dance training, fatigue, and stress, risk factors related to body characteristics and nutrient intake, levels of conditioning, or physical fitness parameters have only recently received the same amount of attention. The aim of the present study was, therefore, to investigate correlations between ballet injury and body fat percentage, active and passive flexibility, lower limb power, upper body and core endurance, and aerobic capacity. Low levels of aerobic fitness were significantly associated with many of the injuries sustained over a 15-week period (r=.590, p=0.034), and body fat percentage was significantly associated with the length of time a dancer was forced to modify activity due to injury (r=-.614, p=0.026). This information may be of benefit to dancers, teachers, physical therapists and physicians in dance schools and companies when formulating strategies to prevent injury.

Professional classical ballet dancers typically face long working days, and many complain of fatigue, particularly as a possible cause of injury. However, little information exists regarding the true physiological demands on dancers. The aim of the present study was therefore to ascertain the daily workload of professional female ballet dancers in terms of work intensity and rest data. Information regarding a single "work day" was obtained from 51 female dancers in one company using a multiple accelerometer. Data were examined for the amount of time spent at work intensities measured in metabolic equivalents (METS)deemed sedentary, low, moderate, and high, and the length of each period at rest. Results indicated significant differences between dancer rankings (corps de ballet, first artist, soloist, and principal) for mean exercise intensity and the percentage of time spent at sedentary intensity (< 3 METS), moderate intensity (3-6 METS) (p < 0.005), and vigorous intensity (6-9 METS) (p < 0.05). The ratios of time spent below 1.5 METS versus time spent above 1.5 METS ("rest" vs. "work") were also significantly different (p < 0.001) between rankings. When rest periods throughout the working day were analyzed, 90% of dancers were found to spend less than 60 consecutive minutes resting at any one time; for 33.3% of dancers this was less than 20 minutes. Results also revealed significant differences (p < 0.05) between dancer rankings for the greatest amount of rest at any one time during the day. It was concluded that female professional classical ballet dancers' ranking in their companies should be considered in devising work-rest schedules to help them to avoid fatigue and resultant injuries.

The physical demands imposed on contemporary dancers by choreographers and performance schedules make their physical fitness just as important to them as skill development. Nevertheless, it remains to be confirmed which physical fitness components are associated with aesthetic competence. The aim of this study was to: 1. replicate and test a novel aesthetic competence tool for reliability, and 2. investigate the association between selected physical fitness components and aesthetic competence by using this new tool. Seventeen volunteers underwent a series of physical fitness tests (body composition, flexibility, muscular power and endurance, and aerobic capacity) and aesthetic competence assessments (seven individual criteria commonly used by selected dance companies). Inter-rater reliability of the aesthetic competence tool was very high (r = 0.96). There were significant correlations between the aesthetic competence score and jump ability and push-ups (r = 0.55 and r = 0.55, respectively). Stepwise backward multiple regression analysis revealed that the best predictor of aesthetic competence was push-ups (R(2) = 0.30, p = 0.03). Univariate analyses also revealed that the interaction of push-ups and jump ability improved the prediction power of aesthetic competence (R(2) = 0.44, p = 0.004). It is concluded that upper body muscular endurance and jump ability best predict aesthetic competence of the present sample of contemporary dancers. Further research is required to investigate the contribution of other components of aesthetic competence, including upper body strength, lower body muscular endurance, general coordination, and static and dynamic balance.

Video analysis of classical ballet to date has been largely limited to examining the artistic elements of choreography. The aim this study was to employ a method of video analysis to describe the physiological demands of classical ballet performance and to examine differences between artists, soloists, and principal dancers. Forty-eight performances [male = 24, female = 24; artists (corps de ballet) = 16, soloists = 16, principals = 16] were analyzed in four fields: work intensity, body movement, partner work, and number of transitory movements occurring per minute. Statistical analysis revealed significant differences between ranks in two intensity bands: time at rest (p < 0.05) and time performing at moderate intensity (p < 0.05), with soloists and principals resting for 75.2 +/- 15.1% and 53 +/- 24.1% of the total performance, respectively (p < 0.05). Principals also spent a significantly greater percentage of time at moderate intensity than both soloists and artists (p < 0.05). Significant differences between males and females (p < 0.05) were seen in the number of lifting and supporting movements performed. It was concluded that classical ballet is an intermittent form of exercise, utilizing both aerobic and anaerobic energy systems, a finding that supports previous studies. The demands of the performances analyzed varied according to role. Therefore, it was also concluded that video analysis can help provide a basis for rank-specific supplemental training.